Complicated Central Nervous System Infection Developing In Association with Dental Abscess in a Child Patient

Dental carries are frequent and can progress to central nervous system infections if untreated. A 17-year old patient presented with fever and unconsciousness. He, who irregularly used oral antibiotic for dental abscess, had fever, unconsciousness, exophtalmus, hyperemia and edema on left side, and meningismus. He had no focal deficit. On laboratory, leukocyte, 22,000/mm; C-reactive protein, 17.4 (0-5) mg/dL. Lumbar puncture could not be performed due to intracranial space occupying lesion suspicion. Intravenous ceftriaxone (100mg/kg/d) and vancomycin (60mg/kg/d) were started. Cranial MRG revealed pansinusitis, meningitis, subdural empyema, left frontoparietal~3x2 cm abscess, destruction and osteomyelitis on neighboring bones. Abscess drainage and resection of infected bone were performed on the fifth day of treatment. Blood, cerebrospinal fluid, and abscess cultures did not grow. He was discharged with 2-weeks of peroral antibiotics, after gradual clinical remission, 4-weeks of parenteral antibiotics, and negative acute phase reactants without any complications and residual neurological symptoms. Odontogenic infections should be considered important due to serious complications.